Nepal: After the Natural Disaster, the Microbial Enemy

The 7.8 magnitude, April 25 earthquake in Nepal is a pointed reminder of the fragility of life and the power of nature. But if other such experiences serve as an example, what began as a battle against a natural disaster could soon become a war against a microbial enemy.

KATHMANDU, NEPAL – APRIL 28: Residents line up for water from a truck near Basantapur Durbar Square on April 28, 2015 in Kathmandu, Nepal. gettyimages.com. used with permission

KATHMANDU, NEPAL – APRIL 28: Residents line up for water from a truck near Basantapur Durbar Square on April 28, 2015 in Kathmandu, Nepal. gettyimages.com. used with permission

At this writing, more than 5,000 have been declared dead and almost twice as many injured. These numbers will rise. Repeated aftershocks are hampering efforts to recover bodies and locate the missing. But the toll may not even end with the conclusion of rescue efforts. Sanitation systems and drinking water infrastructure are broken down or destroyed. Soon, cholera and other hygiene-related outbreaks could replace decimated communities as a disaster relief priority.

Shane Rogers, Clarkson University associate professor of civil & environmental engineering, says a scenario such as Nepal’s is an ideal breeding ground for a pandemic:

People in the modern world often take for granted the safety of their drinking water. Cholera, among other waterborne infectious diseases, has a long history of wreaking havoc where poor sanitary conditions intersect water supplies.

On the same day as the quake, the Times of India announced, “Another Crisis Will Hit Nepal Today – Sanitation.” On April 29, The Guardian wrote “An estimated 4.2 million people are in urgent need of water, sanitation and hygiene support.” And NBC reported:

[L]ast week’s quake created conditions under which cholera and other water-borne diseases thrive: compromised water supply, lack of sanitation, and survivors crowded into tent camps, health officials say.

But the headline of the NBC story illustrated the danger with a dramatic example: “Cholera Fear: Will Haiti’s Hell Come to Nepal After Earthquake.”

Almost all notable outbreaks of Cholera in the last 25 years have been related to poor sanitary conditions and water supplies, and are amplified in times of social disruption. ~ Clarkson Professor Shane Rogers.

Following the 2010 Haiti earthquake, a catastrophic outbreak of cholera afflicted the island nation. In a now sadly ironic twist, Nepalese relief workers brought cholera to a UN camp in central Haiti from which untreated sewage was allowed to flow into the Artibonite River, a source of drinking water. (For a New York Times illustration follow this link.)

Experts understand that hygiene is a science measured by errant microbes, a disturbingly exacting standard in the midst of a disaster the size of Nepal’s or Haiti’s. And contaminated water is a particularly efficient delivery system for viruses and bacteria. Dr. Rogers cites the 19th century experience that first tipped off health professionals:

Between 1815 and 1896, five cholera pandemics claimed the lives of millions. It was during the third of these pandemics that the physician John Snow called for the removal of a handle from the Broad Street Pump in London, relieving their epidemic and proving that an unknown contaminant in the water was responsible.

After the first localized outbreak in Haiti, cholera spread throughout the island of 10.4 million and then to the Dominican Republic, Mexico and Cuba. Just 16 days before the Nepal earthquake, in a story about UN culpability for the cholera outbreak, The Business Insider reported:

To date, the epidemic killed around 9,000 people by the end of 2014 and infected more than 1 in 20 Haitians.

Shane Rogers, Clarkson University associate professor of civil & environmental engineering.

Shane Rogers, Clarkson University associate professor of civil & environmental engineering.

Typically, nations that suffer such consequences were compromised even before natural disasters struck. Dr. Rogers explains :

Almost all notable outbreaks of Cholera in the last 25 years have been related to poor sanitary conditions and water supplies, and are amplified in times of social disruption; this includes the outbreak in Haiti following the 2010 earthquake and movement to refugee camps, in Nigeria related to flooding and poor sanitation, in Somalia and the Democratic Republic of Congo related to disruption from warfare and movement to refugee camps, and more recently an outbreak in Ghana that has claimed hundreds of lives, but has been overshadowed by the Ebola outbreak.

For Nepal, The United Nations has launched a $415 million global appeal to bring aid to the nation of 27 million where more than 2 million are displaced and 8 million affected. The Business Insider story implies mistrust may follow the UN into Nepal because of the Haiti experience, but the situation is so desperate time expended on suspicions could spell lives.

Already there are anecdotal stories that riots have broken out over the lack of drinking water. And, with similar disasters in mind, such as those enumerated by Dr. Rogers, health responders are gearing up for the worst.

In the weeks, maybe years, ahead, Nepal will grapple with the fear that the sick and dying will continue to mount, as it faces perhaps its biggest struggle: winning the battle civilization has fought for centuries — protecting itself from the deadly consequences of its own wastes.